Director Botticelli sits down for “FACE to FACE with SAM”

ONDCP DIRECTOR BOTTICELLI SITS DOWN WITH KEVIN SABET OF SAM IN “FACE TO FACE” SERIES INTERVIEW

Botticelli on marijuana: “Just to be clear, this administration, this office, is opposed to legalization. From the time that I have been in this job, the time that I’ve been in Massachusetts, I’ve never been in favor of either medical marijuana or legalization….you can begin to see that the exact same things that we had to undo with the tobacco industry are now happening with the commercialization of marijuana.”

Botticelli on Colorado: “We’re beginning to see an emerging picture, particularly in Colorado around that… Clearly, there have been some challenges.”

About D.C.’s legalization efforts: “My comments were taken out of context by some as a way to say that I supported marijuana legalization. Nothing can be further from the truth…so I feel like that was a little bit disingenuous and a little bit taken out of context in terms of what those comments were.”

About the Recovery Community: “I do wish the recovery community was much more involved in (anti-legalization efforts).”

WASHINGTON, DC – Last week, in the first of a new series of interviews Smart Approaches to Marijuana (SAM) representatives will conduct with key leaders, SAM President Kevin Sabet sat down with Michael Botticelli, the recently confirmed director of the White House Office of National Drug Control Policy, in Mr. Botticelli’s office at the Executive Office of the President. The interview was a candid conversation about drug policy — especially as it pertains to issues related to marijuana legalization.

“Director Botticelli was refreshingly candid during our interview,” Dr. Sabet said. “He very clearly outlined his unequivocal opposition to legalization and, even more interestingly, he used his own personal, past struggle with addiction to call for the recovery community to speak up about this issue.” The interview can be seen below.

SAM is a non-profit, science-oriented, public health organization dedicated to getting the science out about marijuana and stopping Big Marijuana. It advocates for a health-first approach, and boasts numerous top public health researchers on its advisory board.

TRANSCRIPT:

Kevin: I’m here with Director Botticelli. Michael, thank you so much for being with me. This is the first episode of Face-to-Face with SAM, so thank you for doing this. How do you like it here? You’re getting used to the offices and the digs. What surprised you about your first couple of weeks as director?

Michael: One is that there is a level of authority that confirmation brings that I don’t think I really anticipated until it actually happened. I feel I’ve been given a unique opportunity here to use the next couple years to think about how we advance good science and evidence-based drug policy in the United States. We’re facing some really critical issues, but we also have incredibly exciting opportunities when we think about Criminal Justice Reform and the impact of the Affordable Care Act. Part of the reason I love this job is I feel like there have been very few times over the past thirty years where we’ve had this confluence of better science and better data, better medications, better insurance coverage, parity for insurance coverage. That’s all offset by clearly some urgent and pressing issues that we have before us. It’s one of those things that sometimes I wake up at 3 o’ clock in the morning and say, “Oh, my God. They picked the wrong guy.” But it’s great to be here. It’s great to be having the support of not only ONDCP staff, but also a tremendous amount of supporting partnerships with many organizations on the outside. The continuing focus is how do we make sure we’re all moving together for a common purpose?

Kevin: That’s a very glass-half-full perspective, which is helpful. A pessimist would look at the glass half empty and say this is a very challenging time for drug policy, especially with regard to marijuana and just legalization in general. They would say maybe ONDCP is less relevant than during the crack epidemic, when Congress demanded this kind of coordination. Before asking your opinion on things or the position, how do you see things right now with marijuana? When you think about marijuana, what comes to your mind?

Michael: There are a number of issues. Just to be clear, this administration, this office, is opposed to legalization. This is not from an ideological perspective. When you look at the research, the science, and the data behind the health harms of marijuana, particularly as it relates to youth in this country, I think we have some real challenges and hurdles facing us. The American Academy of Pediatrics did a very thoughtful piece a number of weeks ago. They came out against medical marijuana and legalization, and they did it by looking at all the attendant health harms, particularly as they relate to youth. They said that for any policy position, the most salient criteria should be what its impact is on youth in this country. That I think is where the basis of our policy comes from. We’ve made substantial gains in many areas around public health and substance use in this country when you look at youth who smoked tobacco, youth who used other substances. But unfortunately, marijuana is going in the opposite direction. Clearly, that is tagged to their perception of risk, to the messages.

Kevin: Why do you think it’s gone up?

Michael: Clearly, youth are getting messages that marijuana is a benign substance and in many cases helpful because of medical marijuana. It is astounding to me the speed with which it’s been engrained in popular culture. So it’s hard to turn on a TV show these days and not hear people making jokes about smoking marijuana. So they are getting messages that are very disingenuous and are really not speaking to them about what the health harms are. I’ve talked to many kids across the country, and I often ask them what they think about things, like what do they think about tobacco, and universally kids don’t want to smoke because they know it’s harmful. They’re worried about the chemicals that are in them. But when I ask them about marijuana, it’s the exact opposite. They think it is helpful, so they’re buying into all of the messages that unfortunately legalization efforts have said. I’ve been doing public health work for a long time, and it took us 50 years to undo what the tobacco industry did. I think many of us are concerned that Big Marijuana is using the same strategies. So if you think of what Big Tobacco did, they said, “Our product is helpful. It relaxes you. It makes you feel better.” They had physicians promoting it. They used very funny cartoon characters to market their products and they refused to reveal the ingredients of their products. And I think you can begin to see that the exact same things that we had to undo with the tobacco industry are now happening with the commercialization of marijuana.

Kevin: I have to push back a little bit. People would say, “That’s good. That’s the administration’s position, but we have federal law that covers Colorado. It’s not being enforced. Why not?” It’s a little unfair since you’re new to the position, but you do represent the administration, so why not? What’s going on, as the Control Substances Act, given that it hasn’t changed, why isn’t it (the Controlled Substances Act) being enforced?

Michael: The Department of Justice issued guidance that with limited federal resources we’re not going to go after low-level offenders for this issue. I think they have sent a message to Washington and Colorado via their Cole memo of their eight public health and public safety priorities and they are monitoring the situation to make sure that Colorado and Washington are complying with those. I just spent some time with Colorado Gov. (John) Hickenlooper who quite honestly has not been a supporter of legalization. We’re beginning to see an emerging picture, particularly in Colorado around that. The Department of Justice has clearly said, “We’ll continue to go after what we believe are egregious cases as it relates to public health and public safety issues.” They’ll continue to prosecute those cases where they find them.. I think people conflate sometimes what the Department of Justice will use their limited enforcement resources for versus whether the administration supports legalization.

Kevin: How is that in terms of the monitoring? You’re saying the emerging picture doesn’t look good. Is this something that you and your Justice colleagues are looking at closely?

Michael: Actually, ONDCP has been leading a Federal Interagency [Working] Group to look at federal state and local data to have a much more accurate picture. I think none of us want to react to anecdote, so we want to make sure we have the most robust data that we can to really look at in terms of what is happening in Washington and Colorado. Clearly, there have been some challenges, and I think even Colorado has focused on edibles as a significant issue with emergency department mentions particularly among kids. So even Colorado is understanding that particularly edibles are presenting a problem. There are instances of increased calls to the poison control lines, increased emergency department visits, increases in drugged driving arrests. I think that we again have to continue to rely on the data to give us an accurate picture of what we have.

Kevin: Is there a trigger for enforcement or is there a world where we can imagine one day, it’s going to say, “Oh, we see this x number of increase in problems, and DOJ is going to say, “Great, we’re going to enforce the law now…” Do we know?

Michael: Beyond the eight enforcement priorities in the Cole memo, I don’t think there’s a bright line that’s been determined by the Department of Justice at which point they are going to say we need to take subsequent actions on this. We see our role in terms of making sure that we have the best accurate picture to make that determination.

Kevin: Let’s talk about D.C. You made some comments. A legalization advocate asked you what you think about D.C. and marijuana. And you’re a D.C. resident, and you basically articulated the President’s budget position, which was that we’re not going to interfere in D.C. home rule. Some people interpreted that – and the legalizers certainly did – that federal law doesn’t matter and it is a home rule issue. Here’s a chance to clarify.

Michael: A couple things. One is when we look at how the President has used his budget authority, clearly, he has used home rule and home rule law as a way to continue to make sure that the District doesn’t use federal funds in ways that are against federal policy. For instance, where there have been attempts by Congress to institute restrictions on abortion funding and contraception the President has used the home rule as a way to challenge that. This was standard operating procedure as it relates to the federal budget and putting restrictions on how the District spends its dollars. In those comments I said I was opposed to legalization. My comments were taken out of context by some as a way to say that I supported marijuana legalization. Nothing can be further from the truth. From the time that I have been in this job, the time that I’ve been in Massachusetts, I’ve never been in favor of either medical marijuana or legalization, so I feel like that was a little bit disingenuous and a little bit taken out of context in terms of what those comments were.

Kevin: We’ve seen that, because the narrative the legalization advocates want to paint is that everyone is on their side, and now they can say, “Hey, even the new progressive drug czar’s on our side.” I think that’s something that they love to do. They want to mainstream their message. It’s their press posture M.O. nowadays.

Michael: It was very clear if you look at my entire comments during the course of that whole symposium, and even in the context of those comments, that we continue to oppose legalization.

Kevin: As the first director in recovery, how does this issue and should it affect the recovery community? When I say this issue, I mean legalization because I’ve kind of gotten this sense that it’s easier to ignore the issue for a lot of outside NGOs, frankly. Tell me what you think about that and also how you think this issue affects recovery policy but also recovery from an individual point of view.

Michael: I’ll talk from an individual perspective. I think people in recovery should take their own action. It’s been a long time now, but I think back to my early days of recovery, and I remember how hard it was for me to do things like walk down the street and walk near the bars that I used to hang out. I used to cross the street. And I think we know for people in early recovery, there are lots of triggers, and part of that learning curve of recovery is to learn how to understand what those triggers are. But even 26 years out, it’s a lifelong illness. As a person in recovery, I don’t want to be walking down the street and smell marijuana smoke. I don’t want to be walking down the street and see one more temptation because there is a marijuana dispensary down the street. We are already inundated through every vehicle in this society about issues around substance use and using drugs. I, as a person in recovery, don’t want more of that. I want less of it. I want to live in a healthier community and, quite honestly, I make those choices as a person in recovery. I choose to live in places, specifically in those communities, that are going to support my recovery. It’s a real challenge. There are so many people who don’t make it to long-term recovery. And I think assaulting people with seeing people smoke, and the smell and dispensaries and advertisement is yet one more thing that people, particularly people in early recovery, have to deal with and struggle with. I find it really tragic, quite honestly, that our communities now are making it harder for people particularly in early recovery to sustain that kind of lifestyle.

Kevin: Absolutely. I have a friend, 18 years in recovery, who had to leave a movie theatre in Colorado the other day and call his sponsor because of the smell. It’s amazing.

Michael: It’s very disturbing. On a personal note, I do wish the recovery community was much more involved in this, because I do think a lot of people probably feel the same way that I do. I’ve talked to other people in recovery who do feel the same way. I think our entire movement around recovery community organizations and recovering communities is precisely about how do we create communities that support and sustain people in recovery. I feel like their needs have not been heard and attended to as we think about what’s right to do for our communities. I agree that we’ve got to look at disproportionality in our criminal justice system, but how do we attend to the needs of everybody in our community, and I think the recovery voice often is not vocal. It’s clearly not heard as we’re thinking about, quite honestly, the commercialization.

Kevin: Absolutely. It’s very possible you could serve as a long-serving drug czar, but it’s also possible you will also be one of the shortest given the length of the current administration. Everyone who is in this office, sitting in these chairs, realizes there is a finite amount of time and thinks about, “What do I want to get done?” What are you thinking about as you’re beginning in terms of when you leave in two, five, eight, ten years? What do you want to get done? What do you want to be focusing on?

Michael: One of the biggest challenges that I had to come to terms with when I first came here even as a deputy is to really retrain my mind that I’m here for a time-limited period. I worked for the public health department for twenty years. I was the director in Massachusetts for nine years. So you can think about short-term, medium, long-term goals. But I think about it in a number of ways, and I think there are some things that we can do now that could really impact the trajectory of how we think about substance use issues. Over the next couple years in partnership with many of our partner organizations, I fundamentally believe that we can continue to reframe how people with substance use disorders are perceived in the United States. I really do. We’ve come a long way. I know that lots of polls show that people would rather see people get treatment rather than incarceration, but I also know there are still significant stigma, and people still feel like this is a moral issue. I think that we can really continue to change the way we think about this illness.

Clearly dealing with the prescription drug, heroin and overdose issue is something that I feel particularly important for me and our office. When you look at the morbidity and mortality, we have to focus a lot of time and energy on this. In doing so, I think we can use these opportunities to engage people who have really never cared about drug policy issues before. One of the beneficial things around the magnitude of the opioid issue is that there are a lot more people now at the federal level, at the state level, at the local level who are really concerned about this. I think we should use that as an opportunity to focus on solutions not just specifically as they relate to the heroin and prescription drug issue but that we really begin to implement the systemic changes that we’ve known for a long time need to be put in place. Let me give you an example. Colleagues in Massachusetts have done a great job at making sure that private insurance companies are meeting the requirements of parity, that they’re implementing good, evidence-based programs, that they’re really stepping to the table to do that. It’s those kinds of solutions that I think can work for everybody. The last piece, I give a lot of credit to this administration of focusing on Criminal Justice Reform. I think there are some substantial changes we already have made and that we can continue to make over the next couple years as we think about particularly dealing with people with substance use disorders as it relates to intersection with the criminal justice system.

Kevin: How do we talk about that issue in the nuanced way that it deserves, because clearly, I think it’s oversimplifying when we just say everyone who’s a drug user enters the criminal justice system, it’s only “treatment over incarceration,” because if there’s a crime involved, I think, people are saying there should be some kind of penalty for that in conjunction with treatment. It’s not always treatment over incarceration for a user if they’re there for something other than use.

Michael: I think of it in three buckets. One is we know there is a huge and extraordinary number of people who are intersecting with the criminal justice system largely as a result of their substance use disorder. Only one in ten people [is] getting access to treatment historically.

Kevin: These aren’t people that are in there for drug offenses. These are people that are there, committed their crimes, and they have a drug problem, correct?

Michael: And they have a drug problem, so how do we through policy and practice divert people away? For example, the commissioner of police in New York City has actually begun to open assessment in triage centers. So cops on the beat actually have some place to take someone with a substance use disorder rather than sending them to Rikers Island, which I think is great. So there are things we can do on the policy and practice level to be able to do that. There are certainly those people that you mentioned who need to be incarcerated but also have a substance use disorder, so we want to make sure there’s good, effective treatment behind the walls. We also know that the vast majority of those people are coming back to our community. So how do we make sure we have good reentry services, that we’re linking people to care, that we don’t continue to have real legal and other barriers for people to reengage with their community? No matter where I go across the country, the two biggest issues I hear in terms of people supporting long-term recovery are stable housing and stable employment. If you have a criminal record, your chances are minimal in terms of finding that, so there’s been a lot of work happening particularly through the Reentry Council at the White House as well as at the Department of Justice about how we think about diminishing those real barriers that people have to sustain their recovery.

Kevin: And one of the things that SAM talks about is we don’t need to penalize somebody for life and give them the criminal records, so they can’t go and become productive members of society, because the original intent of these things is to deter.

Michael: Generally, if people don’t commit another crime within three years, there’s very little likelihood for the rest of their life, but often, criminal records are used for much longer periods of time in an effort around public safety. One of the things that I think is really helpful here, is that we really have bipartisan support within Congress, within states for wholesale Criminal Justice Reform. So we have some very conservative states, like Texas and Kansas, who basically realize we cannot sustain these correctional costs, and they’re implementing a wide variety of what we know to be effective practices to keep people out of incarceration.

Kevin: Our field’s challenge is to define that criminal justice reform not by legalization, which is what some people want to define it as, but as real strategies and programs.

Michael: We need trusted messengers in this discussion. I think that there are some people who will always cast a degree of skepticism as it relates to government and what our messages are, but we also want to make sure that we have trusted messengers in the medical field, in all of the areas that we need to do this work, because I think it’s really important for us to make sure that not only are we educating the public but [also] we’re educating other stakeholders in terms of what are the issues that we have here and what do we know to be effective in the work that we do.